- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.03 / $351.03 / $937.66
| Facility | | $351.03 | $351.03 | $937.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.03 / $448.69 / $506.76
| Professional | | $351.03 | $448.69 | $506.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.77 / $527.87 / $676.91
| Facility | | $343.77 | $527.87 | $676.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.15 / $422.30 / $870.99
| Professional | | $211.15 | $422.30 | $870.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.87 / $765.41 / $1,134.56
| Facility | | $527.87 | $765.41 | $1,134.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.24 / $1,161.31 / $1,627.99
| Facility | | $686.24 | $1,161.31 | $1,627.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.71 / $1,277.45 / $2,970.53
| Professional | | $865.71 | $1,277.45 | $2,970.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.08 / $686.23 / $1,232.15
| Professional | | $475.08 | $686.23 | $1,232.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.72 / $739.02 / $976.56
| Professional | | $638.72 | $739.02 | $976.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.71 / $316.72 / $964.42
| Professional | | $221.71 | $316.72 | $964.42 |